Fig-2bAutologous fat transfer is becoming a staple of both reconstructive and aesthetic surgery. Reconstructive uses range from breast reconstruction to the treatment of non-healing wounds. In aesthetic surgery, buttock and breast augmentation in addition to facial injections are common areas for autologous fat transfer.

Previous techniques such as gravity separation, centrifuge spinning, and open- air fat filtering jeopardized fat cell survival, sterility, operative time, and results. In recent years, however, the methods for preparing fat have evolved; starting a revolution in purification technology. Today, our ability to collect and prepare this fat with improved purity and more efficient time is leading to greater surgical use and improved outcomes.

The essential factors of fat preparation include the ability to separate fat cells, wash, and isolate those cells for injection in a sterile, consistent, and time-efficient manner. To that end, Lifecell’s REVOLVETM System incorporates fat collection, filtering, and washing in a single unit. The system allows us to process large volumes of fat, between 300 cc and 400 cc, in less than 10 minutes.

The two most common procedures utilizing autologous fat injections in our practice are breast reconstruction and the Brazilian Butt Lift (gluteal autologous fat augmentation).

Fat Grafting in Practice: Breast Reconstruction

Fig-2cIn breast reconstruction, autologous fat has classically been used for lipofilling contour irregularities in the tertiary stages of the reconstructive algorithm. In our practice, however, we have found that the benefits of autologous fat, and associated adipose-derived regenerative cells, are more advantageous in the setting of radiation therapy and implant reconstruction. Transfer of fat to the entire subcutaneous plane of the irradiated breast improves the quality, volume, and health of tissue prior to the implant placement.

Related Resources

Here a few of the big players in the fat grafting arena.

Lifecell: An Acellity Company

Revolve System

Puregraft

Genesis Biosystems

LipiVage®

MD Resource Corp

Aquavage®

Integra

VIAFILL

Andrew Technologies

Hydrasolve®

Our modified algorithm for delayed-immediate breast reconstruction includes complete subcutaneous autologous fat transfer 3 to 6 months post-radiation therapy followed by implant reconstruction after an additional delay of 3 to 6 months (See Figure 1). In patients who have already undergone implant reconstruction post-radiotherapy and experience radiation-related complications, autologous fat transfer to the entire subcutaneous plane of the irradiated breast can be undertaken followed by revision surgery 3 to 6 months later. Performing the fat transfer and allowing the irradiated breast to heal helps minimize subsequent postoperative complications and leads to improved outcomes.

Fat Grafting in Practice: the Brazilian Butt Lift

The increased interest in gluteal augmentation has resulted in a demand for an efficient fat purification system that can minimize operative time and maximize fat survival. These are crucial factors in patient satisfaction in the cash-pay setting. Using the REVOLVE system, we regularly perform buttock augmentation with 800 cc to 1,000 cc of purified autologous fat. This consistently results in excellent fat retention and surgical collection.

Performing the fat transfer and allowing the irradiated breast to heal helps minimize subsequent postoperative complications and leads to improved outcomes.

We can filter and wash 300 cc to 400 cc in 10 to 15 minutes each round. The system eliminates hours of preparation time from these aesthetic surgeries and translates into safer procedures and improved outcomes. Our average Brazilian Butt Lift patient is receiving 400 cc to 600 cc of autologous fat to each gluteal side using multiple micro fat grafting injections.

As the understanding and science behind autologous fat improves, the surgical and medical indications will continue to grow exponentially in plastic surgery. Additionally, the advances in our scientific understanding of adipose-derived stem cells will likely benefit all branches and fields of surgery and medicine.

John Apostolides, MD, FACS, is a board-certified plastic surgeon in San Diego. He can be reached at PSPeditor@allied360.com.